Hospital cleanliness is measured annually as part of the patient environment action team (PEAT) assessment. The first inspections in 2000 found around one third of national health service trusts to have poor or unacceptable standards. Since then there has been a steady improvement and in 2004-05, fewer than 5 per cent. were classified as poor or unacceptable. The latest PEAT inspections have recently been completed, and the results will be published in due course. However the PEAT scores published in 2004 and 2005 show improved rates of cleanliness in the hospital sites across the strategic health authority areas in the West Midlands.